Project Summary/Abstract: This proposal presents a five-year research career development program focused on the study and development of a dyadic behavioral intervention to improve distress (e.g., depression and anxiety) and communication for older adults coping with cancer and pre-existing mild cognitive impairment (MCI); and for their family caregiver. While MCI in older adults does not overtly impede function, it can manifest under conditions of distress. Close to 50% of older adults with co-occurring cancer and MCI are at vulnerable risk to experience high levels of distress (e.g., depression and anxiety) which can negatively affect their sense of independence, communication of what matters most for their care, and overall quality of life. Their family caregivers may experience equal or even higher levels of distress when managing their loved one’s cancer symptoms and cognitive deficits. Surprisingly, a large gap exists in the development of dyadic behavioral interventions to treat distress and improve communication to address both patient and caregiver needs. The proposed project seeks to address a major gap in the literature and clinical practice for older adults with co- occurring cancer and MCI, and their family caregiver. The overall objective of this K08 proposal is to develop a dyadic intervention (created by Dr. Ramos, titled: COPE+), informed by her previous work in individually based interventions for oncology and palliative care populations, and pilot COPE+ as a novel patient-caregiver dyadic intervention consisting of distress coping skills, and newly include communication-skills training. The proposed mentored research activities for this K08 award are to refine and pilot test the dyadic intervention informed by Family Self-Management Theory. Mentored research training will occur in the context of a focused research project with three aims: 1) To refine the COPE+ intervention using interviews with patients, caregivers and providers. 2) To finalize the intervention and study procedures through user testing. 3) To examine the feasibility and acceptability of COPE+. This K08 application is consistent with NCI’s mission to advance scientific knowledge of the unique needs of people living with cancer and aligns with the NCI’s Division of Cancer Control and Population Sciences in helping reduce the burden of the cancer experience via use of behavioral intervention approaches to enhance quality of life. To become an independent researcher in the field of geriatric oncology and mental health, Dr. Ramos requires additional training in: 1) qualitative research and geriatric oncology; 2) recruitment, engagement, and retention of older adults with cancer and MCI, and their family caregivers; 3) design, develop, and pilot dyadic behavioral interventions; and 4) develop expertise in dissemination and implementation. Dr. Ramos’ intensive training plan coupled with a team of internationally recognized researchers in health psychology, geriatrics...